Newly diagnosed diabetic ? am I type 1 or 2? | Health and Fitness ...

Question by Peener: Newly diagnosed diabetic ? am I type 1 or 2?
I am a 26 year old male and have lost about 20 pounds in the past six months (am now at about 175). My fasting BG was 340 mg/dl, A1C was 10.9%, and high ketones in my urine. I was told by a walk-in clinic internist I was type 2 and started on Metformin (1000 mg twice a day), only ate greens, egg whites, and turkey, and exercised for about 15-20 minutes after each meal. My fasting BG was down to about 95 and postprandial under 150 after 4 days. I saw a new internist who confirmed the type 2 diagnosis and treatment, but gave no advice on diet, except for fat intake.

Five days after the initial diagnosis and start of treatment, I was able to see an endocrinologist who told me I was type 1 due to lack of family history (with the exception of a grandmother who developed diabetes in her sixties after becoming very overweight), age, body type, and ketone levels.

As far as I understand, there is no definitive test to determine if someone is type 1 or 2. The type 1 antibodies are not necessarily present in all type 1 patients, and the c-peptide test is not always reliable.

Additionally, the endocrinologist I saw prescribed 16 units per day of Lantus and a sliding scale of Novolog before each meal starting at 5 units, and going much higher depending on my preprandial BG. I have decreased the Lantus dosage to 14 units due to low fasting BG levels and am now eating 2-4 servings of carbohydrate per day. I have yet to take one unit of Novolog since my fasting and postprandial BG levels have been in the 70-105 and 95-130 range, respectively. Given the ?500 Rule? (500/16), I should only need 1 unit to cover 31 G of carbohydrate assuming I produce no insulin at all, which the endocrinologist did not believe to be the case. Would that 5+ units have put me into a dangerously severe hypoglycemic state? Should I look for a new doctor, or are my fears unfounded?

Thanks in advance for any pointers.
Let me expand a bit on the weight issue. I had lost the 20 lbs before being diagnosed, which is one of the factors the endocrinologist used in his type 1 diagnosis. I am 6?1?, meaning I was probably 5-10 pounds overweight six months ago. I have gained (or stopped losing weight at least) since I began treatment.

I suppose my real question is whether I should be going to see a different endocrinologist to re-evaluate both the diagnosis (1, 2, or LADL all seem like possibilities) and treatment (I honestly think if I had taken the 5+ units of Novolog, it would?ve sent me to the hospital unless I had eaten something equivalent to a loaf of bread).

Best answer:

Answer by NAP BQ
You can test for type 1 vs type 2 by checking your endogenous insulin levels. That is, if you are producing insulin as in type 2, you can measure it. Type 1 you have no insulin. Looks like you were doing well with metformin, so I don?t understand why the endocrinologist was convinced you had type 1. Getting on insulin has its risks! not only can insulin cause hypoglycemic affects that can kill you, but too much insulin causes atherosclerosis and heart disease.

Age is not a reason to say you are type1, since many kids now are diagnosed with type 2. Bottom line is, you need to find out if you have endogenous (from/in your body) insulin production. You can test for antibodies too.

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Tags: diabetic, diagnosed, newly, Type

This entry was posted on Wednesday, March 14th, 2012 at 7:02 pm and is filed under Diets. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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